First Aid for Immersion Hypothermia
In Prince William Sound’s 46°F waters, a person pulled from the sea will quickly suffer from moderate to severe hypothermia. Understanding how to properly treat a cold-water immersion victim on board your vessel is a critical skill that can prevent cardiac arrest and save a life.
The Four Golden Rules of Hypothermia Care
1. Handle the Victim GENTLY
This is the most important rule in hypothermia first aid.
- Why: In a severely hypothermic patient, the heart muscle is cold, extremely irritable, and vulnerable to going into ventricular fibrillation (a fatal cardiac arrest).
- Action: Never jar, shake, or force the victim to stand or walk. Keep the victim in a flat, horizontal position at all times. Move them slowly and gently into the cabin or a sheltered area.
2. Prevent Further Heat Loss
Your primary objective on a small boat is to stop the victim from getting colder.
- Action:
- Get the victim out of the wind and rain immediately.
- Remove wet clothing carefully. If necessary, cut the clothing off to avoid bending or jarring the victim’s extremities.
- Dry the victim’s skin gently.
- Wrap the victim completely in dry clothing, heavy sleeping bags, or wool blankets.
- Add a Vapor Barrier: Wrap a plastic tarp, plastic trash bags, or space blankets over the sleeping bag to trap heat and prevent evaporative cooling. Ensure the head is covered (but leave the face fully exposed for breathing).
3. Rewarm Safely
- Shivering is Good: Active, vigorous shivering is the body’s natural method of producing heat. A shivering victim is still capable of rewarming themselves passively if well insulated.
- Do NOT Rub or Massage: Never rub the victim’s arms or legs, and do not put them in a hot bath. This causes “afterdrop”—cold, acidic blood from the extremities rushes back to the warm body core, causing a drop in core temperature and potential cardiac arrest.
- Active Rewarming (Mild/Moderate Cases Only): If the victim is fully conscious and shivering, you can place warm water bottles (wrapped in towels) or chemical heat packs specifically on the head, neck, armpits, and groin. Never apply direct heat to bare skin.
- No Alcohol or Caffeine: Never give a hypothermia victim alcohol (which dilates blood vessels and increases heat loss) or hot coffee/caffeine. If they are fully conscious and can swallow normally, you may offer warm, sweet liquids (such as warm juice or broth).
4. Secure Emergency Evacuation
Moderately to severely hypothermic victims require professional medical care.
- Action: If the victim is confused, slurring their words, unable to walk, or unconscious, immediately contact the U.S. Coast Guard on VHF Channel 16 or call 907-463-2000 to coordinate a medical evacuation.
- The Golden Axiom: In emergency medicine, “A cold water immersion victim isn’t dead until they are warm and dead.” Even if an unconscious victim appears dead (with no detectable pulse or breathing), initiate CPR gently and continue until medical responders arrive. Submerged victims have been successfully revived after extended periods when handled correctly.